Perioperative Management of a Leadless Pacemaker: The Paucity of Evidence-Based Guidelines

Mickus, Gregory J.; Soliman, George I.; Reed, Ryan R.; Martin, Archer Kilbourne

doi:10.1053/j.jvca.2016.06.021

Cited by 16 publications

(4 citation statements)

References 8 publications

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“…Patients with leadless pacemakers may safely undergo surgery, with precautions similar to patients with conventional pacemakers, avoiding EMI and after reprogramming the pacemaker into nonsensing mode in pacing-dependent patients (due to its intracardiac location and lack of a Hall-effect sensor/reed switch, this device cannot be temporarily reprogrammed to an asynchronous mode with a magnet applied over the body of the pacemaker). 490,491 In patients with ICDs undergoing NCS with anticipated risk of EMI, arrhythmia detection or antiarrhythmic therapies through the device should be switched off before NCS, 492 or a magnet should be put over the device. 488,489,492 All modern ICDs will respond to magnet application by inhibiting antitachycardia therapy, while the brady pacing is left intact.…”

Section: Management Of Patients With Cardiac Implantable Electronic D...mentioning

confidence: 99%

2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery

Halvorsen¹,

Mehilli²,

Cassese³

et al. 2022

European Heart Journal

440

200

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All experts involved in the development of these guidelines have submitted declarations of interest. These have been compiled in a report and simultaneously published in a supplementary document to the guidelines. The report is also available on the ESC website www.escardio.org/Guidelines See the European Heart Journal online for supplementary data that include background information and detailed discussion of the data that have provided the basis of the guidelines.Click here to access the corresponding ESC CardioMed chapters.

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Section: Management Of Patients With Cardiac Implantable Electronic D...mentioning

confidence: 99%

2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery

Halvorsen¹,

Mehilli²,

Cassese³

et al. 2022

European Heart Journal

440

200

View full text Add to dashboard Cite

show abstract

“…Technical support from a CIED team or device manufacturer may be necessary preoperatively to reprogram the device (turn off the antiarrhythmia functions or pace in asynchronous mode) as well as verify the integrity of the CIED function and restore it to the preoperative parameters before discharge home. [96][97][98] Of note, postoperative interrogation for integrity of modern CIEDs can be performed remotely.…”

Section: Anesthesia and Analgesiamentioning

confidence: 99%

Patient Selection for Adult Ambulatory Surgery: A Narrative Review

Rajan

Rosero

Joshi

2021

Anesthesia &Amp; Analgesia

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With migration of medically complex patients undergoing more extensive surgical procedures to the ambulatory setting, selecting the appropriate patient is vital. Patient selection can impact patient safety, efficiency, and reportable outcomes at ambulatory surgery centers (ASCs). Identifying suitability for ambulatory surgery is a dynamic process that depends on a complex interplay between the surgical procedure, patient characteristics, and the expected anesthetic technique (eg, sedation/analgesia, local/regional anesthesia, or general anesthesia). In addition, the type of ambulatory setting (ie, short-stay facilities, hospital-based ambulatory center, freestanding ambulatory center, and office-based surgery) and social factors, such as availability of a responsible individual to take care of the patient at home, can also influence patient selection. The purpose of this review is to present current best evidence that would provide guidance to the ambulatory anesthesiologist in making an informed decision regarding patient selection for surgical procedures in freestanding ambulatory facilities.

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“…Evidence-based guidelines specific to perioperative management of LPs are lacking. Other case reports have also identified the lack of clinical data for perioperative management of LPs and call for further study [ 27 ]. This highlights the need for more studies investigating outcomes under various surgical and anesthetic management conditions of patients with LPs.…”

Section: Micra Vrmentioning

confidence: 99%

Tricuspid Valve Replacement in a Patient with a Leadless Cardiac Pacemaker: Current Guidelines and Recommendations for Perioperative Management

Hames

Hayanga

Schmidt-Krings

et al. 2021

Case Reports in Anesthesiology

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Leadless cardiac pacemakers were developed to reduce complications associated with conventional transvenous pacemakers. While this technology is still relatively new, devices are increasingly being implanted. The perioperative management of patients with these devices has been underreported; we thus seek to add to the limited body of knowledge of perioperative management of patients with leadless cardiac pacemakers. An elderly female patient with a Micra VR transcatheter pacing system leadless cardiac pacemaker placed for tachycardia-bradycardia syndrome with intermittent complete heart block was scheduled for elective tricuspid valve replacement for severe tricuspid regurgitation. Pacemaker interrogation was performed several hours prior to the scheduled surgery based on the electrophysiologist’s availability; the device was kept in its programmed VVIR mode, and the base rate was increased from 60 to 80 beats per minute in anticipation of the upcoming surgery. Upon preoperative evaluation, the anesthesiologist asked that the electrophysiology team be placed on standby intraoperatively due to the concern that either oversensing in the setting of pacemaker dependence and/or undesirable tachycardia from rate-responsive pacing could occur. The surgeon used monopolar electrocautery for the duration of the cardiac surgery. Despite the patient having evidence of pacemaker dependence in the intensive care unit preoperatively, no electromagnetic interference leading to oversensing nor rate modulation was detected during intraoperative electrocardiographic and intraarterial invasive monitoring. Evidence-based guidelines regarding perioperative management specifically of leadless cardiac pacemakers do not exist. As these devices become more prevalent, further evaluation will be paramount to determine whether existing guidelines for perioperative management of conventional transvenous pacemakers apply.

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Perioperative Management of a Leadless Pacemaker: The Paucity of Evidence-Based Guidelines

Cited by 16 publications

References 8 publications

2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery

2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery

Patient Selection for Adult Ambulatory Surgery: A Narrative Review

Tricuspid Valve Replacement in a Patient with a Leadless Cardiac Pacemaker: Current Guidelines and Recommendations for Perioperative Management

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